{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:43:30Z","timestamp":1762177410535,"version":"3.40.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>After one year of the pandemic and hints of seasonal patterns, temporal variations of in-hospital mortality in COVID-19 are widely unknown. Additionally, heterogeneous data regarding clinical indicators predicting disease severity has been published. However, there is a need for a risk stratification model integrating the effects on disease severity and mortality to support clinical decision-making.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a multicenter, observational, prospective, epidemiological cohort study at 45 hospitals in Germany. Until 1 January 2021, all hospitalized SARS CoV-2 positive patients were included. A comprehensive data set was collected in a cohort of seven hospitals. The primary objective was disease severity and prediction of mild, severe, and fatal cases. Ancillary analyses included a temporal analysis of all hospitalized COVID-19 patients for the entire year 2020.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>A total of 4704 COVID-19 patients were hospitalized with a mortality rate of 19% (890\/4704). Rates of mortality, need for ventilation, pneumonia, and respiratory insufficiency showed temporal variations, whereas age had a strong influence on the course of mortality. In cohort conducting analyses, prognostic factors for fatal\/severe disease were: age (odds ratio (OR) 1.704, CI:[1.221\u20132.377]), respiratory rate (OR 1.688, CI:[1.222\u20132.333]), lactate dehydrogenase (LDH) (OR 1.312, CI:[1.015\u20131.695]), C-reactive protein (CRP) (OR 2.132, CI:[1.533\u20132.965]), and creatinine values (OR 2.573, CI:[1.593\u20134.154].<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Age, respiratory rate, LDH, CRP, and creatinine at baseline are associated with all cause death, and need for ventilation\/ICU treatment in a nationwide series of COVID 19 hospitalized patients. Especially age plays an important prognostic role. In-hospital mortality showed temporal variation during the year 2020, influenced by age.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration number<\/jats:title>\n<jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04659187\" xlink:type=\"simple\">NCT04659187<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252867","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T17:34:42Z","timestamp":1623951282000},"page":"e0252867","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Clinical outcome, risk assessment, and seasonal variation in hospitalized COVID-19 patients\u2014Results from the CORONA Germany study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-7749","authenticated-orcid":true,"given":"Nele","family":"Gessler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie A.","family":"Gunawardene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Wohlmuth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juergen","family":"Behr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Gloeckner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Herrlinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hoelting","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich-Frank","family":"Pape","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruediger","family":"Schreiber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel","family":"Stang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claas","family":"Wesseler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Willems","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Arms","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph U.","family":"Herborn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"pone.0252867.ref001","unstructured":"World Health Organization. Coronavirus disease (COVID-19) Weekly Epidemiological Update and Weekly Operational Update [Internet]. Accessed December 3rd 2020. Available from: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/situation-reports\/"},{"issue":"11","key":"pone.0252867.ref002","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1016\/S1473-3099(20)30581-8","article-title":"Observations of the global epidemiology of COVID-19 from the prepandemic period using web-based surveillance: a cross-sectional analysis","volume":"20","author":"FS Dawood","year":"2020","journal-title":"The Lancet Infectious Diseases"},{"key":"pone.0252867.ref003","unstructured":"Robert Koch Institute. COVID-19 profile. Version of 1.4.2021. [Internet] Accesses April 5th 2021. Available from: https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Steckbrief.German"},{"key":"pone.0252867.ref004","unstructured":"Robert Koch Institute. Retrospective classification of COVID-19 pandemic in Germany: Retrospektive Phaseneinteilung der COVID-19-Pandemie in Deutschland bis Februar 2021. Epid Bul 15\/2021. German."},{"issue":"44","key":"pone.0252867.ref005","doi-asserted-by":"crossref","first-page":"27456","DOI":"10.1073\/pnas.2008590117","article-title":"Seasonality and uncertainty in global COVID-19 growth rates","volume":"117","author":"C Merow","year":"2020","journal-title":"Proceedings of the National Academy of Sciences"},{"journal-title":"Improving Survival of Critical Care Patients With Coronavirus Disease 2019 in England, Critical Care Medicine","year":"2020","author":"JM Dennis","key":"pone.0252867.ref006"},{"key":"pone.0252867.ref007","unstructured":"Robert Koch Institute. COVID-19 treatment guidance: Hinweise zu Erkennung, Diagnostik und Therapie von Patienten mit COVID-19. Version of 30.12.2020. [Internet] Accesses January 8th 2021. 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Available from: https:\/\/www.rki.de\/DE\/Content\/InfAZ\/N\/Neuartiges_Coronavirus\/Daten\/Fallzahlen_Kum_Tab.html"},{"key":"pone.0252867.ref014","article-title":"Case characteristics, resource use, and outcomes of 10\u2008021 patients with COVID-19 admitted to 920 German hospitals: an observational study","author":"C Karagiannidis","year":"2020","journal-title":"The Lancet Respiratory Medicine"},{"issue":"12","key":"pone.0252867.ref015","doi-asserted-by":"crossref","first-page":"e0242953","DOI":"10.1371\/journal.pone.0242953","article-title":"Development and external validation of a prognostic tool for COVID-19 critical disease","volume":"15","author":"DS Chow","year":"2020","journal-title":"PLoS One"},{"journal-title":"BMC Infectious Diseases.","article-title":"Proposal of COVID-19 Clinical Risk Score for the management of suspected COVID-19 cases: a case control study","author":"S Nakakubo","key":"pone.0252867.ref016"},{"key":"pone.0252867.ref017","first-page":"m1985","article-title":"Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study","volume":"369","author":"AB Docherty","year":"2020","journal-title":"BMJ (Clinical research ed)"},{"issue":"2","key":"pone.0252867.ref018","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1093\/infdis\/jiaa274","article-title":"Simulated Sunlight Rapidly Inactivates SARS-CoV-2 on Surfaces","volume":"222","author":"S Ratnesar-Shumate","year":"2020","journal-title":"The Journal of Infectious Diseases"},{"issue":"5","key":"pone.0252867.ref019","doi-asserted-by":"crossref","first-page":"574","DOI":"10.3201\/eid0905.020556","article-title":"Seasonal Patterns of Invasive Pneumococcal Disease","volume":"9","author":"SF Dowell","year":"2003","journal-title":"Emerg Infect Dis"},{"key":"pone.0252867.ref020","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jmii.2020.05.013","article-title":"Co-infections among patients with COVID-19: The need for combination therapy with non-anti-SARS-CoV-2 agents?","volume":"534","author":"C-C Lai","year":"2020","journal-title":"Journal of Microbiology, Immunology and Infection"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T17:35:03Z","timestamp":1623951303000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252867"}},"subtitle":[],"editor":[{"given":"Raffaele","family":"Serra","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,17]]},"references-count":20,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0252867","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,6,17]]}}}